Provider Demographics
NPI:1942044458
Name:SHIRA, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SHIRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MALHEUR ESD
Mailing Address - Street 2:363 A STREET WEST
Mailing Address - City:VALE
Mailing Address - State:OR
Mailing Address - Zip Code:97918
Mailing Address - Country:US
Mailing Address - Phone:541-473-3138
Mailing Address - Fax:541-922-6699
Practice Address - Street 1:MALHEUR ESD
Practice Address - Street 2:363 A STREET WEST
Practice Address - City:VALE
Practice Address - State:OR
Practice Address - Zip Code:97918
Practice Address - Country:US
Practice Address - Phone:541-473-3138
Practice Address - Fax:541-922-6699
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12154853235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist